1奇美醫學中心 外科部 泌尿外科
Perioperative and Long-term Oncological Outcomes of Patients with Muscle Invasive Bladder Cancer Who Underwent Radical Cystectomy: A Single-center Experience
Wen-Hsin Tseng1、Chien-Liang Liu1、Steven K. Huang1、 Allen W.Chiu2、
1Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
2Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
Radical cystectomy (RC) has been the standard of treatment for muscle invasive bladder cancer (MIBC). However, bladder preservation with maximal transurethral resection of the bladder tumor, followed by concurrent chemoradiotherapy, is a category 1 treatment option in the recent National Comprehensive Cancer Network guideline for these patients. Most urologists preferred bladder preservation because RC is still associated with high mortality and morbidity risk. However, recent improvements in operative techniques, device, and perioperative care have reduced mortality and morbidity rates. This study aimed to report the postoperative and long-term oncological outcomes of patients with MIBC who underwent RC.
Materials and Methods:
Between January 2012 and December 2018, 207 patients were diagnosed with MIBC at our center. From these patients, 61 underwent RC, and the mean follow-up duration was 39.8 months. Patients with metastatic disease, received other treatments, and lost to follow-up were excluded. Postoperative complications were graded based on the Clavien–Dindo classification within 90 days and 1 year after RC. Each tumor stage was compared for disease-free survival (DFS) and overall survival (OS) rates. Risk factors for postoperative complication, recurrence, and survival were assessed.
The patients (n = 61) had mean 20.9 days of hospital stay, and the most common complications of RC were blood transfusion (27.9%), infection (18%), and percutaneous nephrostomy (11.5%). All complications were classified below grade 3 of Clavien–Dindo classification, and most of them were controlled by conservative treatment. Five patients (8.2%) had re-operation within 90 days for enterolysis or cystorrhaphy, and no mortality was reported after RC. The 1-, 3-, 5-year DFS rates were 85.2%, 69.7%, and 57.6%, respectively, and the 1-, 3-, 5-year OS rates were 90.2%, 72.5%, and 60.5%, respectively. The Charlson comorbidity index was independently associated with postoperative complication, recurrence, and survival rate.
The postoperative and survival outcomes of RC in this study have much improved compared with those in previous studies. Better perioperative and long-term oncological outcomes are possible with proper surgical technique, appropriate selection of patients for urinary diversion, and proper patient management in the pre-, peri-, and postoperative period.